两种关节周围局部注射配方对全膝关节置换术后镇痛效果的研究

Analgesic Results of Two Different Formulations Injected in Periarticular Knee after TKA

目的比较两种不同关节周围软组织局部注射配方对全膝关节置换术后的镇痛效果。方法由同一组医师主刀完成的全膝关节置换术(TKA)治疗骨性关节炎(OA)66例(66膝),根据关节周围软组织注射镇痛药配方不同,随机分成两组,各33例(33膝)。传统组注射布比卡因、甲基强的松龙、肾上腺素、吗啡和生理盐水混合液;改良组注射罗哌卡因、酮咯酸、肾上腺素、吗啡和生理盐水混合液,比较术后两种镇痛配方在运动、静止时疼痛视觉模拟评分(VAS)、术后镇痛药的使用量、切口并发症和患者恶心、呕吐及心脏毒性反应的发生率。结果两组术后的24 h运动和静止VAS、术后镇痛药使用量和切口并发症差异明显,有统计学意义(P<0.05);两组患者均有恶心、呕吐等胃肠道不适,但发生率差异无统计学意义(P>0.05);两组患者无一例出现心脏毒性反应。结论关节周围软组织注射改良组混合局麻药优于传统组,更有利于TKA术后的镇痛,减少了术后止痛药使用量和术后切口并发症,使用更安全。

Objective To compare the analgesic effect of two different formulations of local injection in periarticular after TKA. Methods A series of 66 cases of osteoarthritis（OA）, all patients who underwent total knee arthroplasty （TKA） by the same surgeon team, were random- ly divided into two groups, eaeh group with 33 cases （ 33 knees） .Two formulations of analgesics drugs were used respectively in different group.The first group was injected with drugs：bupivacaine,methylprednisolone, epinephrine, morphine and saline. The formulation in the other group were ropivacaine, ketorolae, epinephrine, morphine and saline. The postoperative visual analog scores （VAS） of pain at motionless and motion phrase, dose of analgesia postoperation,eomplieafions of incision,incidence of patient discomfort with nausea, vomiting and the ineidenee of eardiae toxicity were observed perioperative periods.Results The differences between groups of VAS at motionless and motion phrase in 24 hours after operation, dose of analgesia and incidence of incisional complication were statistically.different （P 〈0.05）. There were no statistical significance in incidence of patient discomfort of nausea, vomiting and others （P 〉 0.05）. Cardiac toxicity did not appear in both the groups. Conclusion The anesthetic effect of bupivacaine, methylprednisolone, epinephrine, morphine and saline is better than the other formulation after TKA, with lower complication.